Misdiagnosed illnesses, denied payments and a shortage of trained medical personnel in government-run clinics are wrecking the federal healthcare system for Native Americans, tribal leaders said Tuesday as they pressed officials to overhaul a system beset with problems.
With the head of the Indian Health Service listening on, representatives of seven Montana and Wyoming reservations delivered a litany of healthcare woes suffered by their members during a U.S. Senate Indian Affairs Committee field hearing in Billings.
They described an agency compromised by a bloated bureaucracy and unable to fulfill its core duty to provide health care for more than 2 million American Indians and Alaska Natives.
"All too often, tribal members complain of ailments but get sent home from the Indian Health Service with cough medicine or pain killers. Later we learn the situation is much more serious, like cancer," said A.T. "Rusty" Stafne, chairman of the Assiniboine and Sioux Tribes of northeast Montana's Fort Peck Indian Reservation.
"We have lost fathers, mothers, sons, daughters, brothers and future leaders because they were unable to get the healthcare they need," he said.
Indian Health Service acting director Yvette Roubideaux said in response that changes are underway, including reforms meant to streamline the bureaucratic hurdles faced by patients. But she acknowledged greater efforts were needed at the local level, and that more money will be required than the $4.4 billion the federal agency receives annually.
"I've never thought you could fix the Indian Health Service in a day or overnight," Roubideaux said.
The U.S. government provides health care to American Indians and Alaska Natives as part of its trust responsibility to tribes that gave up their land when the United States was being formed. Yet Roubideaux said federal healthcare spending on American Indians lags far behind spending on other groups such as federal employees, who receive almost twice as much on a per-capita basis.
Meanwhile, American Indians suffer from higher rates of substance abuse, assault, diabetes and a slew of other ailments compared to other races.
In Montana, the life expectancy for Native American women is 62 years, compared to 82 years for white women. Native men have a life expectancy of 56 years, versus 75 years for white men, according to the state Department of Public Health and Human Services.
While Tuesday's hearing focused on Montana and Wyoming — the two states served by the Indian Health Service regional office in Billings — Committee Chairman Sen. Jon Tester said the concerns he heard are shared by tribes across the West.
The Montana Democrat promised additional hearings, and he said he wants more emphasis on patients and less on administrative oversight. The reforms undertaken by the government so far, he added, fall short.
"I don't think the realization of these reforms is doing what we need to do, which is better healthcare on the ground," said Tester, whose committee has jurisdiction over federal-government dealings with 566 American Indian and Alaska Native tribes.
Tuesday's hearing followed complaints from the Crow Tribe and others about poor and delayed healthcare on reservations.
Tester and U.S. Sen. John Walsh earlier this month asked the U.S. Government Accountability Office to examine problems at the agency's area office in Billings.
Former Indian Affairs Chairman Sen. Byron Dorgan of North Dakota conducted a similar investigation in 2010. Dorgan found that a "chronic state of crisis" plagued healthcare services for American Indians. Problems included a lack of providers, hospitals at risk of losing their accreditation, improperly licensed staff and missing or stolen narcotics.